Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

PURPOSE The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients. METHODS We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 health care clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England. RESULTS Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication. CONCLUSIONS The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care

Системный анализ эффективности функционирования электрических машин в горнодобывающем комплексе

Представлена методология, позволяющая оценить и обеспечить эффективность функционирования электрических машин с точки зрения системного анализа. Произведено дезагрегирование цели на составные элементы, которые отражены в виде дерева целей, что позволяет изучить структуру обеспечения эффективности эксплуатации и обслуживания электрических машин. На основе экспертной оценки определены коэффициенты относительной важности компонентов дерева целей. Методология может быть использована для выявления и структуризации проблем, связанных с эксплуатацией и обслуживанием электрических машин

Effect of different shading intensities on growth and yield of cherry tomato

Cherry tomato (Solanum lycopersicon var cerasiforme) is small size fruits, with a bright red colour resembling to cherry and becoming popular in the retail chains which are marketed at a premium price. The field experiment was conducted to study the effect of different (35, 50 and 75 per cent) shading intensities on growth and yield (qha-1 ) of cherry tomato. Significantly maximum yield was recorded in 35 per cent shading intensity and genotype Kalash Seeds Product (KSP)-113 (579.44 and 503.88 q ha-1 , respectively). Among the different shading intensities and genotypes, maximum plant height was observed in 75 per cent shading intensity and genotype KSP -113 at 30 days interval (74.70 and 60.95 cm, respectively). The minimum days to 50% flowering of cherry tomato were observed in cherry tomatoes grown under 35 per cent shading intensity (45.00 days) as compared to other shading intensities while minimum days to 50% flowering were observed in genotype KSP-113 (44.00 days). The maximum length of the cluster (9.58 cm), the weight of cluster (27.67 g), number of fruits per cluster (9.42) and number of pickings (11.67) were observed in 35 per cent shading intensities and in genotype KSP-113. The cultivation of KSP-113 genotype under 35 per cent shading intensity was found to be most sustainable for improving growth and yield of cherry tomato during the summer season

Genome-wide analysis of cAMP-response element binding protein occupancy, phosphorylation, and target gene activation in human tissues

Hormones and nutrients often induce genetic programs via signaling pathways that interface with gene-specific activators. Activation of the cAMP pathway, for example, stimulates cellular gene expression by means of the PKA-mediated phosphorylation of cAMP-response element binding protein (CREB) at Ser-133. Here, we use genome-wide approaches to characterize target genes that are regulated by CREB in different cellular contexts. CREB was found to occupy approximate to 4,000 promoter sites in vivo, depending on the presence and methylation state of consensus cAMP response elements near the promoter. The profiles for CREB occupancy were very similar in different human tissues, and exposure to a cAMP agonist stimulated CREB phosphorylation over a majority of these sites. Only a small proportion of CREB target genes was induced by cAMP in any cell type, however, due in part to the preferential recruitment of the coactivator CREB-binding protein to those promoters. These results indicate that CREB phosphorylation alone is not a reliable predictor of target gene activation and that additional CREB regulatory partners are required for recruitment of the transcriptional apparatus to the promoter

Retrospective analysis of necropsy findings in patients of H1N1 and their correlation to clinical features

India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough , and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage . The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage ( DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had either polymorphonuclear or mononuclear infiltrate. Furthermore, necrotizing pneumonitis pattern seen on these patients is the likely cause of mortality in these patients. Although clinical ARDS pattern was noted in all these patients, it was well correlated in lung pathology in all these cases

Advances in chemical and biological methods to identify microorganisms—from past to present

Fast detection and identification of microorganisms is a challenging and significant feature from industry to medicine. Standard approaches are known to be very time-consuming and labor-intensive (e.g., culture media and biochemical tests). Conversely, screening techniques demand a quick and low-cost grouping of bacterial/fungal isolates and current analysis call for broad reports of microorganisms, involving the application of molecular techniques (e.g., 16S ribosomal RNA gene sequencing based on polymerase chain reaction). The goal of this review is to present the past and the present methods of detection and identification of microorganisms, and to discuss their advantages and their limitations.C.F.R. would like to thank the Portuguese Foundation for Science and Technology (FCT–Portugal) for the C.F.R. for the project UID/EQU/00511/2019—Laboratory for Process Engineering, Environment, Biotechnology, and Energy—LEPABE funded by national funds through FCT/MCTES (PIDDAC) and N.M. for the Strategic project ref. UID/BIM/04293/2013 and “NORTE2020 - Programa Operacional Regional do Norte” (NORTE-01-0145-FEDER-000012)

The relationship between retinal vessel calibre and knee cartilage and BMLs

10.1186/1471-2474-13-255BMC Musculoskeletal Disorders13

In Vivo Evaluation of the Biocompatibility of Surface Modified Hemodialysis Polysulfone Hollow Fibers in Rat

Polysulfone (Psf) hollow fiber membranes (HFMs) have been widely used in blood purification but their biocompatibility remains a concern. To enhance their biocompatibility, Psf/TPGS (d-α-tocopheryl polyethylene glycol 1000 succinate) composite HFMs and 2-methacryloyloxyethyl phosphorylcholine (MPC) coated Psf HFMs have been prepared. They have been evaluated for in vivo biocompatibility and graft acceptance and compared with sham and commercial membranes by intra-peritoneal implantation in rats at day 7 and 21. Normal body weights, tissue formation and angiogenesis indicate acceptance of implants by the animals. Hematological observations show presence of post-surgical stress which subsides over time. Serum biochemistry results reveal normal organ function and elevated liver ALP levels at day 21. Histological studies exhibit fibroblast recruitment cells, angiogenesis and collagen deposition at the implant surface indicating new tissue formation. Immuno-histochemistry studies show non-activation of MHC molecules signifying biocompatibilty. Additionally, Psf/TPGS exhibit most favorable tissue response as compared with other HFMs making them the material of choice for HFM preparation for hemodialysis applications

Sacrificial-template-free synthesis of core-shell C@Bi2S3 heterostructures for efficient supercapacitor and H-2 production applications

Core-shell heterostructures have attracted considerable attention owing to their unique properties and broad range of applications in lithium ion batteries, supercapacitors, and catalysis. Conversely, the effective synthesis of Bi2S3 nanorod core@ amorphous carbon shell heterostructure remains an important challenge. In this study, C@Bi2S3 core-shell heterostructures with enhanced supercapacitor performance were synthesized via sacrificial-template-free one-pot-synthesis method. The highest specific capacities of the C@Bi2S3 core shell was 333.43 F g(-1) at a current density of 1 A g(-1). Core-shell-structured C@Bi2S3 exhibits 1.86 times higher photocatalytic H-2 production than the pristine Bi2S3 under simulated solar light irradiation. This core-shell feature of C@Bi2S3 provides efficient charge separation and transfer owing to the formed heterojunction and a short radial transfer path, thus efficiently diminishing the charge recombination; it also facilitates plenty of active sites for the hydrogen evolution reaction owing to its mesoporous nature. These outcomes will open opportunities for developing low-cost and noble-metal-free efficient electrode materials for water splitting and supercapacitor applications

On-farm evidence on breaking yield barriers through optimizing wheat cropping system in Indo Gangetic Plain

The wheat production in the food basket of South Asia has plateaued with threats of environmental sustainability and posing a serious challenge to future food security. For sustainable wheat production in conventional rice-wheat (CTRW) systems under changing climatic scenario, atwo-year on-farm study was conducted. We evaluated system optimization practices (SOP) of legume inclusion with CTR-zero-tillage (ZT) wheat-mungbean (CTR-ZTWMb) and direct seeded rice-ZT wheat-mungbean (DSR-ZTWMb) and triple ZT (raised bed) based futuristic systems of maize-wheat-mungbean (ZTMWMb) and soybean-wheat-mungbean (ZTSWMb). The global warming potential (GWP) of wheat production was significantly reduced by 811 kg CO2 eq/ha (783−861) in the SOP compared to CTRW. Moreover, the water usein wheat reduced by 85.9 and 85.2 ha-mm/ha in CTR-ZTWMb and DSR-ZTWMb with higher reduction in ZTMWMb and ZTSWMb by128.7 and 118.0 ha-mm/ha, respectively over CTRW. Similarly, the total weed density was reduced at 60 (39 and 52 %) and 90 (38 and 49 %) days after sowing with CTR-ZTWMb and DSR-ZTWMb over CTRW. However, the weed density reduction was lesser with ZTSWMb and ZTMWMb at 60 (3.0 and 23.6 %), and 90 (9.8 and 31.0 %) days after sowingcompared to the CTRW.The partial factor productivity (PFP) of NPK applied was 8.5–19.0 % higher under SOP over the CTRW. The use of non-renewable energy in wheat cultivation was reduced by 24.4–28.9 % with SOP over CTRW. The enhancement in wheat grain yield (7.4–11.8 %) and net returns (98–169 US$/ha) was also recorded with CTR-ZTWMb and DSR-ZTWMb and this gain in futuristic systems (ZTMWMb and ZTSWMb) was much higher in grain yield (17.2–21.0$/ha) over CTRW. The adoption of these SOPs on 1 million ha could produce 0.37–1.05 million t additional wheat over CTRW. The on-farm study evidenced thatwheat production with system optimization practices of legume inclusion and zero tillage are better alternatives to achieve higher productivity and profitability with a lesserenvironmental footprint in Indo-Gangetic Plains and similar agroecological regions